Scalable and Resilient SARS-CoV2 testing in an Academic Centre

The emergence of the novel coronavirus SARS-CoV-2 has led to a pandemic infecting more than two million people worldwide in less than four months, posing a major threat to healthcare systems. This is compounded by the shortage of available tests causing numerous healthcare workers to unnecessarily self-isolate. We provide a roadmap instructing how a research institute can be repurposed in the midst of this crisis, in collaboration with partner hospitals and an established diagnostic laboratory, harnessing existing expertise in virus handling, robotics, PCR, and data science to derive a rapid, high throughput diagnostic testing pipeline for detecting SARS-CoV-2 in patients with suspected COVID-19. The pipeline is used to detect SARS-CoV-2 from combined nose-throat swabs and endotracheal secretions/ bronchoalveolar lavage fluid. Notably, it relies on a series of in-house buffers for virus inactivation and the extraction of viral RNA, thereby reducing the dependency on commercial suppliers at times of global shortage. We use a commercial RT-PCR assay, from BGI, and results are reported with a bespoke online web application that integrates with the healthcare digital system. This strategy facilitates the remote reporting of thousands of samples a day with a turnaround time of under 24 hours, universally applicable to laboratories worldwide.

The strength of weak embodiment.

While popular within some cognitive science approaches, the embodiment approach has still found resistance, particularly in light of evidence arguing against strong forms of embodiment. Among other things, the embodiment approach breaks away from the Cartesian ontology of the modulatory system. We claim that the advantages of the embodiment approach are: a) it grounds cognition into modal experience, b) it is harmonious with a materialist philosophy of mind (emergent materialism), and c) it is supported by experimental research in various fields. However, embodiment must still address abstractions, theoretical misunderstandings (representations vs non-representations) and neuroscientific findings that challenge the extension and relevance of sensorimotor properties into cognitive processes. While the strong version of embodiment is seriously challenged by conceptual and physiological setbacks, its weak version is supported by compelling evidence. We suggest future research focus on the psychophysiological bases of grounded cognition and redirect efforts towards the field of cross-modal correspondence.

La teoría de la cognición corporeizada se separa de una ontología cartesiana basada en el sistema modular. Las ventajas del enfoque de la corporeización son: a) enraiza la cognición en la experiencia modal, b) está en armonía con una filosofía materialista de la mente (materialismo emergente), y c) está respaldada por la investigación experimental en varios campos. Sin embargo, la corporeización todavía debe dar cuenta de las abstracciones, los malentendidos teóricos (representación vs. no representación) y los hallazgos neurocientíficos que desafían la relevancia de las propiedades sensoriomotoras en los procesos cognitivos. Mientras que la versión fuerte de la corporeización se ve seriamente desafiada por los retos conceptuales y fisiológicos, su versión débil es respaldada por evidencia convincente. Sugerimos que la investigación futura se centre en las bases psicofisiológicas de la cognición corporeizada y redirija los esfuerzos hacia el campo de la correspondencia intermodal.

Atrial adaptive rate pacing in sick sinus syndrome: effects on exercise capacity and arrhythmias.

OBJECTIVE: To test the hypotheses that adaptive rate atrial (AAIR) pacing: significantly increases maximal exercise capacity, and results in significant suppression of supraventricular and ventricular arrhythmia compared with fixed rate atrial (AAI) pacing. DESIGN: Prospective, randomised, single blind, crossover study with maximal treadmill exercise testing and 24 hour ambulatory electrocardiographic monitoring in AAIR and AAI modes. SETTING: Regional pacing centre. PATIENTS: 30 consecutive patients (mean SD age 65 (12) years) with sick sinus syndrome who required permanent pacing, without evidence of conduction disturbance on 12 lead electrocardiograms or 24 hour ambulatory electrocardiographic monitoring and without other cardiovascular or systemic disease. INTERVENTIONS: Activity sensing or minute ventilation driven systems (AAI/AAIR) were implanted alternately. RESULTS: The mean (SD) peak heart rate in AAI mode was 122(28)v 130(22) in AAIR mode (p < 0.02) for the whole group and 104(17) v 120(5) (p < 0.003) for the patients with chronotropic incompetence. Exercise time was 12.3 (4.1) minutes in AAI and 12.3 (3.8) minutes in AAIR mode (NS) in the chronotropically incompetent patients. There were no significant differences in the Borg scores at peak exercise in AAI v AAIR mode in either group. The frequency per hour of atrial and ventricular arrhythmias showed no significant differences between the two modes in either the group as a whole or in the subgroups with chronotropic incompetence. CONCLUSION: AAIR pacing confers little benefit in sick sinus syndrome compared with AAI pacing.

Symptomatology and quality of life in patients with rate-responsive pacemakers: a double-blind, randomized, crossover study.

Although the hemodynamic advantages of rate-responsive (RR) pacing are well established, the symptomatic benefits remain controversial and the effects on the quality of life have not been assessed. Sixteen patients with RR pacemakers and a mean age of 56 (range 22-77) years were involved in a double-blind crossover study to assess their exercise capacity (treadmill testing), symptomatology, and quality of life (structured questionnaires). Pacemakers were implanted because of symptomatic heart block or sick sinus syndrome. Ventricular demand pacemakers were randomly programmed into the constant rate (VVI) or RR pacing modes for four-week study periods. All patients exercised longer in the RR mode than in the VVI mode (570 +/- 29 vs. 437 +/- 17 s, p less than 0.001). Statistically significant improvements in "shortness of breath" and "energy during daily activities" as measured by a 10-point scale were reported in the RR pacing mode by the patients and were also observed by their close relatives. Symptoms such as "chest pain" and "palpitations" were not worsened during RR pacing. Nondisease-specific "quality of life" was studied in 11 patients using the Nottingham Health Profile which showed a trend for an improved quality of life in five of the six dimensions of perceived health, although none of the changes were statistically significant. This study suggests that RR pacing should be recommended in selected patients on symptomatic grounds.